anna in med school

My eldest brother’s words.  The manner in which he said it…it just kind of rings true.

My dad married Krystyna, his partner of the last five years, this past weekend.  The ceremony was exactly them, held at the Arlington Arts Center, with about 40 of their closest family and friends in attendance.  They wrote their own vows.  My uncle served as celebrant.  It was followed by a champagne toast–during which Krystyna’s deceased husband’s college friends gave them their blessing–and a spectacular dinner at Willow Bar & Restaurant.

Of course, in our rush to pack post-shelf exam Friday afternoon, John and I forgot our camera.  So, until I harass the more responsible of the siblings, these will be our blurry snapshot of events.

I can’t believe that it was the first time in 3 years that all the siblings got together, and we didn’t manage one group photo.  Pathetic.

What is not pathetic: my almost 70-year-old father’s bachelor party.  He drank my husband and brothers under the table.  Anna Lynn and I foolishly stayed up until 2:30 Saturday morning for our “better” halves to return safely.  John walked in first, saluted us, and marched up the stairs without a word.  Several minutes later, Steph (brother 1) came through the front door with an unknown man, each supporting one arm of Eric (brother 2).  Anna Lynn and I eventually deduced that unknown dude was, in fact, the taxi driver.  I’m not sure what’s worse: 1) my party-animal older brother, the former lead guitarist of metal band Johnnie Psycho (I kid you not), was out-drunk my his father and came home nearly unconscious, supported by two grown men; or 2) my main squeeze, most considerate man on the planet, left said brother in taxi without thought of how other brother would manage bringing him in unassisted.  Well played, fellas.

I scrubbed into my first surgery today.  Lucky for me, it was one of those 10-hour ones.  I loved every minute…except when I had to interrupt the surgeon while I was retracting the abdominal wall to ask if I could be excused.  Four hours of burning flesh, the scent just kind of hit me and, as I started to sweat profusely, I feared I might vomit inside of the body cavity.  Surgeons are pretty serious about maintaining a sterile field.

Today: Family Medicine, including joint exam

Tomorrow: Internal Medicine, including separate clinical exam (four patients, 15 min each, with notes)

Wish me luck!

I ran into one of my classmates yesterday evening who mentioned that she was discouraged that she has yet to be in a clinical setting during rotations where she could really see herself professionally, and it reminded me that I should be looking out for what I want to do with my life.  Although I have more questions than ever before, I’m starting to think that having a longitudinal relationship with my patients is important to me.  I’m in the last week of my family medicine rotation, and I’ve seen at least a half dozen patients for the second or third time–and I really like that.  Nothing terribly profound or specific, but it might rule out…I don’t know…surgical trauma?–except, of course, for the unfortunate repeat customers.

I think they just made me a better person.  I’m noticing myself glaring a lot less frequently at the undergrads in the library checking facebook and whining without regard to decibel level.

Tomorrow I’m giving a presentation on seizures, and I’m reading about how drinking too much water can cause one’s cells to swell, an excess accumulation of water in the brain, seizures, brain damage, coma, and death.  I am absolutely disgusted by the number of small children who have died this way because their parents thought it would be a creative punishment to make them drink a gallon of water in one sitting.  Also revolting is this story of a woman who died after consuming too much water in an effort to win a radio contest for a Nintendo Wii video game system.

I’ve been meaning to write about crying for some time…more than just the “and then I cried” that typically follows most of my little diatribes.  During a Doctoring session a couple weeks ago, I commented on my clinic experiences so far: “I’m having the best time…but, I mean, I cry all the time.”

The response I got following that session floored me.  Many of my colleagues are also having clinical experiences complete with–let’s just say it–sometimes straight out weeping…and no, they were not only women or only the “emotional” ones.

I’m not sure I have anything to profound to say…just a quick explanation, then a  criticism:

In my mind, there are two main reasons for emotionally crumbling on the wards:

1. We’re in hospitals.  We care for sick or injured patients, who are often in a great deal of pain, discomfort, and confusion.  We develop relationships with our patients and their families.  And sometimes people die.  Or we send them home with the expectation that they will die shortly.  This is sad stuff.  We’re human.
2. We show up for an average of six 12-hour shifts a week, feel entirely incompetent, try our damnedest to complete tasks that it would take anyone else on the care-providing team a fraction of the time to complete (and that will most likely have to be redone by someone else anyway), and then retreat to a hole somewhere to study for the remainder of waking hours.  It’s frustrating.  And it’s exhausting to be horrible at something for that many hours a week, ya know?

My crying breakdown: 5% point 1; 95% point 2.

A criticism:

I’m an easy crier.  I’ve been like this my whole life, and it’s embarrassing.  But sometimes I can’t help but wonder…I cry when I’m frustrated…so?  I’m not unkind to my colleagues.  I’m not callous or short with my patients.  I don’t throw scalpels.  Seriously, if that’s the worse thing I do when I’m frustrated, what do I need to be embarrassed about?  The face of the medical profession is going to look a lot different in 10 years.  Throwing scalpels is already considered unacceptable by many practices, and I anticipate that won’t be the only change in expectation.

When I felt my phone vibrate in my white coat pocket yesterday, I knew it was one of my closest friends telling me that he had been accepted into the Penn Med Class of 2016!!!

My hands were, however, unable to reach the phone…they were otherwise occupied draining several ounces of pus out of an abscess on the left buttock of a patient.  And this moment also marked my first time using a scalpel on a live person.  Surgery starts in a week and a half!

Win: Today I diagnosed a woman with Benign Paroxysmal Positional Vertigo.  Then I watched her physician successfully treat her using the Epley maneuver.

Fail: It took me three (successful) sticks to draw her blood.  I blame her adorable small children, who had apparently reached their witching hour.  At every vial exchange, they decided it was the appropriate time to either crash into the table on which her arm was propped or propel themselves into her arms.

The family practice where I’m learning still provides home visits (pretty awesome, yeah?), and I get to make a few on my own each week.  Right now, I’m following two patients regularly–one suffering from a disease of the mind, the other of the body.  Not surprisingly, the priorities of these visits are different.

During one, I find myself answering, every two minutes or so, “Where are you from?”  “Where in Virginia?”  “How many children do you have?”  I’m there to engage him, to change up the screen, though he won’t remember me after I’ve left.

The other, I’m checking for sites of infection, monitoring his airway, assessing level of pain and comfort and, as happened in minute one of my first visit, being the periodic target of projectile sputum via tracheostomy tube.